However, this finding may be due to other disorders. Computed tomography CT angiography CT angiography In computed tomography CT , which used to be called computed axial tomography CAT , an x-ray source and x-ray detector rotate around a person.
In modern scanners, the x-ray detector usually Transesophageal echocardiography Echocardiography and Other Ultrasound Procedures Ultrasonography uses high-frequency ultrasound waves bounced off internal structures to produce a moving image.
It uses no x-rays. Ultrasonography of the heart echocardiography is one of Without treatment, the death rate is high within the first 2 weeks and varies depending on the location of the dissection. Of people who survive more than 2 weeks, one third eventually die of complications of the dissection, and the other two thirds die of other disorders.
People with an aortic dissection are admitted to an intensive care unit, where their vital signs pulse, blood pressure, and rate of breathing are closely monitored. Death can occur a few hours after an aortic dissection begins. Therefore, as soon as possible, drugs are given intravenously to reduce the heart rate and blood pressure to the lowest level that can maintain a sufficient blood supply to the brain, heart, and kidneys.
The lower heart rate and blood pressure help limit the spread of the dissection. Soon after drug therapy begins, doctors must decide whether to recommend surgery or to continue drug therapy without surgery. Doctors almost always recommend surgery for dissections that involve the first few inches of the aorta ascending aorta closest to the heart, unless complications of the dissection make the risk of surgery too high.
If the aortic valve is leaking, surgeons repair or replace it. Removal and repair of a dissected aorta usually takes 3 to 6 hours, and the hospital stay is usually 7 to 10 days. For dissections in the aorta farther from the heart descending aorta , doctors usually continue drug therapy without surgery or consider placement of an endovascular stent graft, To do an endovascular stent graft procedure, doctors thread a long, thin wire through the large artery in the groin femoral artery and up to the dissecting area.
Then they slide the stent graft, which is a hollow tube like a collapsible straw, over the wire and inside the damaged area of the aorta. Then the stent graft is opened, forming a stable channel for blood flow.
This procedure takes 2 to 4 hours, and the hospital stay is usually 1 to 3 days. Stent grafts, which are less invasive than open surgery, have improved the survival rate and lowered the risk of complications for people with dissections of the descending aorta. Surgery or a stent graft repair is always necessary if the dissection causes the artery to leak blood, blocks the blood supply to the legs or to vital organs in the abdomen, causes symptoms, is enlarging, or occurs in a person with Marfan syndrome Marfan Syndrome Marfan syndrome is a rare hereditary disorder of connective tissue, resulting in abnormalities of the eyes, bones, heart, blood vessels, lungs, and central nervous system.
All people who have an aortic dissection, including those treated surgically, have to take drug therapy to keep their blood pressure down, usually for the rest of their lives. Such therapy helps reduce stress on the aorta. It often does not cause symptoms; however, high blood pressure can increase the risk of stroke, heart attacks, and heart failure. Therefore, it is important Cholesterol-lowering drugs and diet modification are used if the person has atherosclerosis.
Doctors watch closely for complications that can occur in people who have had an aortic dissection. The most important are another dissection, development of aneurysms Overview of Aortic Aneurysms and Aortic Dissection The aorta, which is about 1 inch 2. Any of these complications may require surgical repair.
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